OBJECTIVEComplications occur in diabetes despite rigorous efforts to control risk factors. Since 2000, the National Development Programme for the Prevention and Care of Diabetes has worked to halve the incidence of amputations in 10 years. Here we evaluate the impact of the efforts undertaken by analyzing the major amputations done in 1997–2007.RESEARCH DESIGN AND METHODSAll individuals with diabetes (n = 396,317) were identified from comprehensive national databases. Data on the first major amputations (n = 9,481) performed for diabetic and nondiabetic individuals were obtained from the National Hospital Discharge Register.RESULTSThe relative risk for the first major amputation was 7.4 (95% CI 7.2–7.7) among the diabetic versus the nondiabetic population. The standardized incidence of the first major amputation decreased among the diabetic and nondiabetic populations (48.8 and 25.2% relative risk reduction, respectively) over 11 years, and the time from the registration of diabetes to the first major amputation was significantly longer, on average 1.2 years more. The cumulative five-year postamputation mortality among diabetic individuals was 78.7%.CONCLUSIONSIn our nationwide diabetes database, the duration from the registration of diabetes to the first major amputation increased, and the incidence of major amputations decreased almost 50% in 11 years. Approximately half of this change was due to the increasing size of the diabetic population. The risk for major amputation is more than sevenfold that among the nondiabetic population. These results pose a continuous challenge to improve diabetes care.

ObjectiveLow socioeconomic position is a known health risk. Our study aims to evaluate the association between socioeconomic position (SEP) and lower limb amputations among persons with diabetes mellitus.DesignPopulation-based register study.SettingFinland, nationwide individual-level data.ParticipantsAll persons in Finland with any record of diabetes in the national health and population registers from 1991 to 2007 (FinDM II database).MethodsThree outcome indicators were measured: the incidence of first major amputation, the ratio of first minor/major amputations and the 2-year survival with preserved leg after the first minor amputation. SEP was measured using income fifths. The data were analysed using Poisson and Cox regression as well as age-standardised ratios.ResultsThe risk ratio of the first major amputation in the lowest SEP group was 2.16 (95% CI 1.95 to 2.38) times higher than the risk in the highest SEP group (p<0.001). The incidence of first major amputation decreased by more than 50% in all SEP groups from 1993 to 2007, but there was a stronger relative decrease in the highest compared with the lowest SEP group (p=0.0053). Likewise, a clear gradient was detected in the ratio of first minor/major amputations: the higher the SEP group, the higher the ratio. After the first minor amputation, the 2-year and 10-year amputation-free survival rates were 55.8% and 9.3% in the lowest and 78.9% and 32.3% in the highest SEP group, respectively.ConclusionsAccording to all indicators used, lower SEP was associated with worse outcomes in the population with diabetes. Greater attention should be paid to prevention of diabetes complications, adherence to treatment guidelines and access to the established pathways for early expert assessment when diabetic complications arise, with a special attention to patients from lower SEP groups.

The standardized, population-corrected incidence of major LEA, the minor-major LEA ratio, and major-amputation-free survival proved useful as indicators in comparing the outcomes of diabetic foot care.

Aims/hypothesis We analysed whether the prognosis of a first acute coronary syndrome (ACS) in patients treated for type 2 diabetes has improved. We also compared the trends in patients with and without diabetes. Methods We used national registers to identify all patients with clinically known type 2 diabetes in Finland during the years 1988 to 2002 (n=222,940). All first-ever ACS events (n=43,412) among these patients were identified using the Hospital Discharge Register and the Causes of Death Register. From the National Cardiovascular Disease Register we identified all first ACS attacks (n=191,403) among non-diabetic patients in the country. Finally, we calculated annual age-standardised case fatality rates for ACS for three time periods: prehospital, days 0 to 27 and days 28 to 364 after the first ACS. Results The case fatality rate of first ACS declined significantly in both sexes at all time points considered. The declining trends were not different between patients with type 2 diabetes and those without. Among men aged 35 to 74 years, 58.5% (95% CI 57.6-59.4%) with type 2 diabetes and 44.1% (95% CI 43.8-44.5%) without diabetes had died from cardiovascular causes 1 year after their first ACS. Among women of the same age, the corresponding figures were 54.2% (95% CI 53.0-55.4%) and 36.5% (95% CI 35.9-37.1%). Men generally had higher case fatality rates than women. However, except for prehospital deaths, diabetic women had the same or even higher case fatality rates than non-diabetic men. Conclusions/interpretation The case fatality rates for first ACS show similar improving trends in patients with type 2 diabetes and in those without. However, case fatality rates have remained higher in patients with type 2 diabetes.

The incidence of major amputation is declining in the diabetic population. This positive development can be explained by more active vascular operative treatment. Regional differences are wider than acceptable.